医学
阿托伐他汀
内科学
比例危险模型
心脏病学
瑞舒伐他汀
强度(物理)
临床终点
旁路移植
动脉
冠状动脉疾病
危险系数
外科
他汀类
血运重建
冠状动脉搭桥手术
置信区间
射血分数
随机对照试验
物理
量子力学
作者
Yong Ho Jang,Ki Hong Choi,Young Bin Song,Dong Seop Jeong,Joo‐Yong Hahn,Seung‐Hyuk Choi,Wook Sung Kim,Hyeon–Cheol Gwon,Young Tak Lee
标识
DOI:10.1016/j.athoracsur.2021.08.024
摘要
The current study sought to investigate the association between statin intensity and long-term clinical outcomes according to initial clinical presentation after coronary artery bypass grafting (CABG).The 6531 patients who underwent CABG included in this study were classified into 4 groups according to statin intensity: 731 in the no or low statin group (atorvastatin <10 mg), 2310 in the lower-moderate group (atorvastatin 10-mg equivalent), 2404 in the higher-moderate group (atorvastatin 20-mg equivalent), and 1086 in the high-intensity group (atorvastatin ≥ 40-mg equivalent). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 5 years. Multivariate Cox and inverse probability weighting methods were performed to adjust for baseline differences.At least moderate-intensity statin use was associated with significantly lower risk of 5-year MACCE compared with no or low-intensity statin use (hazard ratio [HR], 0.694; 95% confidence interval [CI], 0.493-0.977; P = .036). Among patients who were taking at least a moderate-intensity statin, both higher-moderate intensity (HR, 0.622; 95% CI, 0.479-0.807; P < .001) and high-intensity statin (HR, 0.613; 95% CI, 0.421-0.894; P = .011) groups showed significantly lower risks of MACCE than the lower-moderate intensity statin group at 5 years after CABG. There was no significant difference in the risk of MACCE between higher-moderate intensity and high-intensity statin groups (HR, 0.987; 95% CI, 0.661-1.475; P = .950). Multivariable Cox and inverse probability weighting methods yielded similar results. In a subgroup analysis compared with the use of a lower-moderate intensity statin, the use of a higher-moderate or high-intensity statin (equivalent dose with atorvastatin ≥20 mg) was associated with a significantly lower risk of MACCE among CABG patients who presented with acute coronary syndrome but not in those who presented with stable ischemic heart disease (interaction P = .001).The use of a lower-moderate intensity statin (atorvastatin 10-mg equivalent) was associated with relatively poorer long-term clinical outcomes than the use of higher-moderate or high-intensity statin, especially in acute coronary syndrome patients after CABG.
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